NY republicans added an amendment (the Collins Amendment) that the states can't bill the counties for Medicaid anymore. That was clever: now they have the votes from all the NY republicans, some of whom (Collins) come from districts where over 80% of property taxes go straight to Medicaid. But if it passes, NY will have to come up with $2.3 billion dollars. They _could_ reduce Medicaid benefits, but I think they'll opt to raise income taxes and blame republicans for it.

New York treats Medicaid like a jobs program. They're not about to reduce it... if you want gold plated Medicaid benefits, move here!

They don't have the votes to pass it, so holding the vote now would mean shooting it down.

Still no CBO score on the new version, but the last one said we would end up with even fewer people with coverage than we had before the ACA. Think about that, the republican plan is to not only undo all of the gains from Obamacare, but to actually make things worse than they were before Obamacare. It's literally worse than a straight up full repeal of the ACA would be.

So I'm not surprised they are getting pushback from within their own party, some of those folks are smart enough to read the writing on the wall. This plan does not make America great again, it makes it worse than it was before and they already know what a powerful campaign issue healthcare can become.

But they still might get something through, to save face. They have to pass some token version of the bill, or else it looks like the party is completely incapable of governing. After so many years of obstructionism, I'm not sure they even know how to do anything else except grind the gears of government.

Re: states rights. Looks like our governor is taking a page from the Southern playbook:

"... If the bill were to pass both houses of Congress, Gov. Andrew Cuomo said he'd sue the federal government if the amendment proposed by Reps. Chris Collins and John Faso shift the cost of Medicaid from the counties to the state is approved. Cuomo, in a conference call with reporters, argued that the amendment could be unconstitutional because it violates state sovereignty." (from Politico's local daily mailer on NY Healthcare Reform).

CBO scored the AHCA revisions. They've covered zero additional lives (so, for those keeping score, 24m will lose coverage), and now saves just $150b over 10 years. That means the latest changes did no good at all, and cost $187b.

I stand by my prior comment: this has no chance to pass in its current form. On the plus side, the Republican plan is so weak, we may keep Obamacare. People seem to like it a lot more today than they did last November.

Re: states rights. Looks like our governor is taking a page from the Southern playbook:

"... If the bill were to pass both houses of Congress, Gov. Andrew Cuomo said he'd sue the federal government if the amendment proposed by Reps. Chris Collins and John Faso shift the cost of Medicaid from the counties to the state is approved. Cuomo, in a conference call with reporters, argued that the amendment could be unconstitutional because it violates state sovereignty." (from Politico's local daily mailer on NY Healthcare Reform).

CBO scored the AHCA revisions. They've covered zero additional lives (so, for those keeping score, 24m will lose coverage), and now saves just $150b over 10 years. That means the latest changes did no good at all, and cost $187b.

I stand by my prior comment: this has no chance to pass in its current form. On the plus side, the Republican plan is so weak, we may keep Obamacare. People seem to like it a lot more today than they did last November.

Strangely enough, Trump might help with keeping the ACA, since he's trying to bully and threaten the GOP into passing the AHCA, giving them the ultimatum that if they don't pass it, Obamacare stays.

(And I think he's just vindictive enough that he'd veto any future version of the AHCA Congress came up with just to spite them for not bowing down to him.)

Mr. Trump, in a telephone interview moments after the bill was pulled, blamed Democrats and predicted that they would seek a deal within a year after, he asserted, “Obamacare explodes” because of higher premiums.

In addition, as I type, Paul Ryan is giving a press conference that appears to be focused on how Obamacare remains the law of the land but is only going to get worse and worse.

So it seems the GOP's next step might be to revert to the tactic of trying to sabotage the ACA (refusing to enforce the individual mandate, proclaiming that we are in a death spiral in the hopes of creating a self-fulfilling prophecy, etc.) and then pinning the blame on the Democrats.

Mr. Trump, in a telephone interview moments after the bill was pulled, blamed Democrats and predicted that they would seek a deal within a year after, he asserted, “Obamacare explodes” because of higher premiums.

In addition, as I type, Paul Ryan is giving a press conference that appears to be focused on how Obamacare remains the law of the land but is only going to get worse and worse.

So it seems the GOP's next step might be to revert to the tactic of trying to sabotage the ACA (refusing to enforce the individual mandate, proclaiming that we are in a death spiral in the hopes of creating a self-fulfilling prophecy, etc.) and then pinning the blame on the Democrats.

Pin schmin. The GOP is in charge of everything. Everything is their fault. That's what the dems should be saying.

Also, all of the law remains in place. So... while they can try to sabotage it, folks will still get subsidies, minimum coverage benefits, Medicaid expansion etc. It will be especially good for the states that work with the ACA (most blue states).

So it seems the GOP's next step might be to revert to the tactic of trying to sabotage the ACA (refusing to enforce the individual mandate, proclaiming that we are in a death spiral in the hopes of creating a self-fulfilling prophecy, etc.) and then pinning the blame on the Democrats.

See, this is perfect for them. Their constituents get to keep their subsidized healthcare, and they get to continue to campaign against Obamacare as a wedge issue. Everyone wins when the republicans don't get what they want!

It didn't have to be this way. Trump could have abandoned the freedom caucus and tried to triangulate with conservative democrats to fulfill his campaign promises of better cheaper coverage for everyone. Cut the extreme fringe of your own party out of the equation by cooperating with the opposition where you can find common ground, that also happens to be widely popular with the public. Bill Clinton did exactly this trick, from the other side.

But instead of actually becoming the populist he pretended to be during the campaign, trump is such a political noob that he got schooled by his crazy/crafty advisors. Priebus and Ryan and Bannon et al. took him on a ride down to DC 101, and I think he's just now realizing exactly how far in over his head he really is. These guys play rough! They appear to have their own agendas and are not purely loyal to me! I feel so used!

Here's a tip, POTUS. If you're not controlling the people in your administration, then they are controlling you. Maybe try to figure out why.

So it seems the GOP's next step might be to revert to the tactic of trying to sabotage the ACA (refusing to enforce the individual mandate, proclaiming that we are in a death spiral in the hopes of creating a self-fulfilling prophecy, etc.) and then pinning the blame on the Democrats.

See, this is perfect for them. Their constituents get to keep their subsidized healthcare, and they get to continue to campaign against Obamacare as a wedge issue. Everyone wins when the republicans don't get what they want!

It didn't have to be this way. Trump could have abandoned the freedom caucus and tried to triangulate with conservative democrats to fulfill his campaign promises of better cheaper coverage for everyone. Cut the extreme fringe of your own party out of the equation by cooperating with the opposition where you can find common ground, that also happens to be widely popular with the public. Bill Clinton did exactly this trick, from the other side.

But instead of actually becoming the populist he pretended to be during the campaign, trump is such a political noob that he got schooled by his crazy/crafty advisors. Priebus and Ryan and Bannon et al. took him on a ride down to DC 101, and I think he's just now realizing exactly how far in over his head he really is. These guys play rough! They appear to have their own agendas and are not purely loyal to me! I feel so used!

Here's a tip, POTUS. If you're not controlling the people in your administration, then they are controlling you. Maybe try to figure out why.

I feel like this is giving Ryan too much credit. He also appears to be an incredibly incompetent schmuck heading up Amateur Hour. However, it's possible that he was trying to present the most un-passable bill possible the entire time.

Sure, it's possible that "designed to fail" was part of the plan all along.

I think the problem for republicans was in asking conservatives to vote FOR something, like subsidies they don't like, as part of a larger package deal. If they had instead had just floated a bill to repeal all of the taxes on rich people, and do nothing else, I think every single republican would have voted for that. They love to vote against taxes, and they could then blame the democrats for not being able to do more unless the country elects them a GOP supermajority.

They could have claimed victory for overturning part of the ACA, left good health insurance in place for their constituents, preserved their favorite campaign issue for the base, presented a unified win for the cheetoh monster, and appeased their ultra wealthy party backers with billions of $. While simultaneously undermining the ACAs future by turning it into s budget buster.

That's only one of about five different paths I can see that they could have taken, that would have been better for them. I'm still not sure if their avoidance of these better outcomes was deliberate or due to incompetence.

Mr. Trump, in a telephone interview moments after the bill was pulled, blamed Democrats and predicted that they would seek a deal within a year after, he asserted, “Obamacare explodes” because of higher premiums.

In addition, as I type, Paul Ryan is giving a press conference that appears to be focused on how Obamacare remains the law of the land but is only going to get worse and worse.

So it seems the GOP's next step might be to revert to the tactic of trying to sabotage the ACA (refusing to enforce the individual mandate, proclaiming that we are in a death spiral in the hopes of creating a self-fulfilling prophecy, etc.) and then pinning the blame on the Democrats.

Pin schmin. The GOP is in charge of everything. Everything is their fault. That's what the dems should be saying.

Yep. Obamacare, at this point, IS Trumpcare. If the Republicans can't repeal, and the Republicans can't replace, then the Republicans endorse the ACA. If they fuck with it, it is on them. If they can't fix it, it is on them.

Obama ain't the president anymore. And people want their goddamn healthcare.

Mr. Trump, in a telephone interview moments after the bill was pulled, blamed Democrats and predicted that they would seek a deal within a year after, he asserted, “Obamacare explodes” because of higher premiums.

In addition, as I type, Paul Ryan is giving a press conference that appears to be focused on how Obamacare remains the law of the land but is only going to get worse and worse.

So it seems the GOP's next step might be to revert to the tactic of trying to sabotage the ACA (refusing to enforce the individual mandate, proclaiming that we are in a death spiral in the hopes of creating a self-fulfilling prophecy, etc.) and then pinning the blame on the Democrats.

Pin schmin. The GOP is in charge of everything. Everything is their fault. That's what the dems should be saying.

Yep. Obamacare, at this point, IS Trumpcare. If the Republicans can't repeal, and the Republicans can't replace, then the Republicans endorse the ACA. If they fuck with it, it is on them. If they can't fix it, it is on them.

Obama ain't the president anymore. And people want their goddamn healthcare.

I am curious how the blame will fall. I doubt they quite 'own' it just yet but they can't really say its great, evil democrats doing this now. Maybe it will be seen more abstract in another year as more problems arise from it as something to be fixed, or Trump and Ryan will work with some purple dems. We shall see.

30-40% of the healthcare dollar is spend on End-of-Life care. How about claw back provisions to Tax Estates of patients who partake in exhaustive (and often unhelpful) End-of-Life care.

Let patients and their families ration their own care, being as they are going to pay for it.

I'd only tax it at about 10-20%. So if 200K is spent on Mr. Magoo, who at 98 has been hospitalized 80 times for heart failure, is admitted again for heart failure, and decides to have "Full Code" provisions leading to 10 days in the ICU while on the Ventilator, then the estate would pay back medicare 20K.

African-Americans and Hispanics are at higher risk of obesity and high blood pressure. Shall we institute a black tax, too?

Heck why stop there? Let's examine folks suns exposure so we can determine who's at higher risk for skin cancer. Promiscuous people should be pay more than virgins as they are at higher risk for STDs.

And what about people with guns?They have a higher chance of shooting themselves than the rest.There should be a database of who and what they have.For example someone with a Mosin-Nagant 91/30 tuned to 1" groups at 100yards should pay less than Garth with Glock that has a sticky magazine due to an ice-cream incident who would probably shoot the doorman of the range while aiming at a barn door at arms length.

African-Americans and Hispanics are at higher risk of obesity and high blood pressure. Shall we institute a black tax, too?

Absolutely ridiculous comparison. Fat people ARE fat. They aren't just risks of being fat, they already are.

Why should insurance companies not be able to charge more for that? They're higher risks.

Let me ask you this. If you own a car insurance company, would you charge someone with a squeaky clean record for 30 years the same as someone that has been in 7 accidents in the last 2 years? Of course not.

I guess that makes me an evil capitalist scum, or whatever you guys call us nowadays.

African-Americans and Hispanics are at higher risk of obesity and high blood pressure. Shall we institute a black tax, too?

Absolutely ridiculous comparison. Fat people ARE fat. They aren't just risks of being fat, they already are.

Why should insurance companies not be able to charge more for that? They're higher risks.

Let me ask you this. If you own a car insurance company, would you charge someone with a squeaky clean record for 30 years the same as someone that has been in 7 accidents in the last 2 years? Of course not.

I guess that makes me an evil capitalist scum, or whatever you guys call us nowadays.

So a fair comparison to someone who is "fat" is someone getting into car accidents? So which car is equivalent to an underactive thyroid? How about a pregnant woman? Would a woman expecting triplets pay 3 times as much since she is 3 times as "fat?"

African-Americans and Hispanics are at higher risk of obesity and high blood pressure. Shall we institute a black tax, too?

Absolutely ridiculous comparison. Fat people ARE fat. They aren't just risks of being fat, they already are.

Why should insurance companies not be able to charge more for that? They're higher risks.

Let me ask you this. If you own a car insurance company, would you charge someone with a squeaky clean record for 30 years the same as someone that has been in 7 accidents in the last 2 years? Of course not.

I guess that makes me an evil capitalist scum, or whatever you guys call us nowadays.

So a fair comparison to someone who is "fat" is someone getting into car accidents? So which car is equivalent to an underactive thyroid? How about a pregnant woman? Would a woman expecting triplets pay 3 times as much since she is 3 times as "fat?"

It's a fair comparison because they're both more risky insurance holders, thus they should be charged more. Don't see how you don't get that. An underachieve thyroid, first off, is almost never the case when it comes to someone being fat. Even if it is a thyroid issue, it still doesn't change the fact that it's calories in vs. calories out. But, if we really wanted to stretch the comparison out, I guess the best comparison would be a legally blind driver. Sure, if they just started driving, they haven't gotten into an accident yet, but if you're a car insurance company, would you honestly not charge them more, because there's a much higher chance you'll have to pay for it?

African-Americans and Hispanics are at higher risk of obesity and high blood pressure. Shall we institute a black tax, too?

Absolutely ridiculous comparison. Fat people ARE fat. They aren't just risks of being fat, they already are.

Why should insurance companies not be able to charge more for that? They're higher risks.

Let me ask you this. If you own a car insurance company, would you charge someone with a squeaky clean record for 30 years the same as someone that has been in 7 accidents in the last 2 years? Of course not.

I guess that makes me an evil capitalist scum, or whatever you guys call us nowadays.

So a fair comparison to someone who is "fat" is someone getting into car accidents? So which car is equivalent to an underactive thyroid? How about a pregnant woman? Would a woman expecting triplets pay 3 times as much since she is 3 times as "fat?"

The pregnancy comment is just stupid. Pregnancy =/= obesity.

Actually a pregnant woman gains a considerable amount of fat during pregnancy as her body changes and prepares for the baby. So yes, they could absolutely be considered overweight and/or obese by conventional standards. And after pregnancy, since the body has adapted to natural changes, the ability to lose the weight becomes much more difficult.

Not really the same as driving a car. Not even in the same universe comparison wise.

Actually a pregnant woman gains a considerable amount of fat during pregnancy as her body changes and prepares for the baby. So yes, they could absolutely be considered overweight and/or obese by conventional standards.

Pregnancy is a temporary condition that should already be accounted for in insurance costs anyways. It's not due to bad eating habits or an unhealthy lifestyle. Huge difference.

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And after pregnancy, since the body has adapted to natural changes, the ability to lose the weight becomes much more difficult.

But still calories in vs. calories out.

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Not really the same as driving a car. Not even in the same universe comparison wise.

The original comparison is valid. A bad driver is more risk. A fat person is more risk. Both should be charged more.

If you're a health insurance company, and you have two people, one that rarely ever has medical issues, and another who is in the hospital multiple times per month, would you charge them the same? If you say yes, then that's great for you, but that's not how business works.

The point of insurance is to spread the risk around a large pool of people

Changing behavior of people is definitely a good goal, but insurance shouldn't be used as a cudgel against people you are morally opposed to.

In order to have insurance that spreads the risk around a large pool of people, you have to have different rates for people with different risks, or you have to have a pool of people with similar risks. Insurance is just a financial instrument.

The point of insurance is to spread the risk around a large pool of people

Changing behavior of people is definitely a good goal, but insurance shouldn't be used as a cudgel against people you are morally opposed to.

In order to have insurance that spreads the risk around a large pool of people, you have to have different rates for people with different risks, or you have to have a pool of people with similar risks. Insurance is just a financial instrument.

And it's a poor mechanism for pursuing redistribution.

I've only ever been on employer insurance so that has not been true IME.

My take on this all is that everyone benefits if the people around them are healthier. You don't have to pick up the slack for co-workers taking sick days or personal days to care for sick relatives, the people around you are less stressed and more pleasant, you name it. It's a good thing.

So I'm willing to pay a little extra so that fat guy over there can get his bariatric surgery, so he can have the energy to do his job a little better. Or to improve the status of any seriously ill person so ease the burden on their caregivers.

My take on this all is that everyone benefits if the people around them are healthier. You don't have to pick up the slack for co-workers taking sick days or personal days to care for sick relatives, the people around you are less stressed and more pleasant, you name it. It's a good thing.

So I'm willing to pay a little extra so that fat guy over there can get his bariatric surgery, so he can have the energy to do his job a little better. Or to improve the status of any seriously ill person so ease the burden on their caregivers.

And that's fine. But what if I'm not willing to pay a bit extra? Why should I be forced to? It's not my fault that people overeat.

My take on this all is that everyone benefits if the people around them are healthier. You don't have to pick up the slack for co-workers taking sick days or personal days to care for sick relatives, the people around you are less stressed and more pleasant, you name it. It's a good thing.

So I'm willing to pay a little extra so that fat guy over there can get his bariatric surgery, so he can have the energy to do his job a little better. Or to improve the status of any seriously ill person so ease the burden on their caregivers.

And that's fine. But what if I'm not willing to pay a bit extra? Why should I be forced to? It's not my fault that people overeat.

We've been over this before. We all hate fat lazy people who get multiple surgeries. But since deciding who deserves to live is a slippery slope, we've kind of decided as a society to let it slide.

My take on this all is that everyone benefits if the people around them are healthier. You don't have to pick up the slack for co-workers taking sick days or personal days to care for sick relatives, the people around you are less stressed and more pleasant, you name it. It's a good thing.

So I'm willing to pay a little extra so that fat guy over there can get his bariatric surgery, so he can have the energy to do his job a little better. Or to improve the status of any seriously ill person so ease the burden on their caregivers.

And that's fine. But what if I'm not willing to pay a bit extra? Why should I be forced to? It's not my fault that people overeat.

Uhm yeah. If the law says that we all pay in so that we all get covered, then yeah you pay extra. You can whine about it and throw a tantrum if you want, but you will pay.

If you're a health insurance company, and you have two people, one that rarely ever has medical issues, and another who is in the hospital multiple times per month, would you charge them the same?

Absolutely. Healthcare is a right, not a privilege for those with better genes.

Obesity is almost never a gene issue, and even when it is, you still have control of just how obese you become.

With that being said, since we disagree that healthcare is a right, I don't think we'll agree on anything that builds upon that idea. Why is it that you believe healthcare is a right?

Better question. Why do you believe only certain people should be provided healthcare?

No, that's not a better question. It's a strawman. I never said that.

Car insurance companies can drop people for deeming them too high risk. Remember the analogy you said was valid? Is it now no longer valid because it doesn't fit your agenda?

Outside of using your analogy against you, poor people who are discriminated against because of their perceived eating habits and required to pay more in healthcare premiums, will absolutely not be able to afford healthcare. And where do you draw the line and how do you test to determine it's precisely form poor eating habits? Do you follow them into McDonalds? What if they just gave birth and have a considerable amount of weight to lose? How much time do you give them to lose the weight? What if their child develops cancer and they have to spend their free time attending cancer treatments and therefore don't have the time to focus on diet and exercise?

And where do you in fact draw the line? My friend has a genetic pre-disposition to ALS since his mom died form it recently. Should he be charged more?

How about those serving in the military? They are certainly more likely to be injured or die, especially in combat. What about those who drive more? Sit behind a desk more often for their job? All folks making choices that increase certain health risk.

African-Americans and Hispanics are at higher risk of obesity and high blood pressure. Shall we institute a black tax, too?

Absolutely ridiculous comparison. Fat people ARE fat. They aren't just risks of being fat, they already are.

Why should insurance companies not be able to charge more for that? They're higher risks.

Let me ask you this. If you own a car insurance company, would you charge someone with a squeaky clean record for 30 years the same as someone that has been in 7 accidents in the last 2 years? Of course not.

I guess that makes me an evil capitalist scum, or whatever you guys call us nowadays.

If the bill as drafted read "community rating doesn't apply for fat people (seriously, put down the cheetos, fatties)" then this analysis would be relevant. However, the repeal of community rating and the return of charging based on pre-existing conditions doesn't just apply to fat people who you personally think deserve it. It catches 4 year old with leukemia, premature babies, people with MS, people with breast cancer, people with anemia, people who almost died giving birth, people with sports injuries, and a whole list of other medical problems that can't easily be blamed on the sufferers. The only relevant discussion applies to the bills under consideration, and the AHCA in various versions doesn't have special provisions for making fat people suffer while innocent children with pre-existing conditions are spared. So, we can argue until we are blue in the face about whether fat people deserve it, but the discussion we should be having is whether we should vote for people who think that people with pre-existing conditions of any kind should be charged more/denied insurance.

If you're a health insurance company, and you have two people, one that rarely ever has medical issues, and another who is in the hospital multiple times per month, would you charge them the same? If you say yes, then that's great for you, but that's not how business works.

Gee, it's almost as if the profit motive confounds the general welfare when it comes to healthcare payment and delivery. WHO KNEW!?

Let me ask you this. If you own a car insurance company, would you charge someone with a squeaky clean record for 30 years the same as someone that has been in 7 accidents in the last 2 years? Of course not.

You are correct. But you are forgetting the difference between car insurance/health insurance companies and the government. Insurance companies are supposed to turn a profit. The government is supposed to serve the people, and make our lives better.